tbuckley/cabot-search huggingface dataset:
Abstract 14579: Predictors of In-Hospital Mortality in Coronary Artery Dissection Patients: An Insight From the National Inpatient Sample Database
Authors: Ghulam Mujtaba Ghumman, Jay Shah, Maen Al-Dabbas, Muhammad Shayan Khan, Kritika Luthra, Amir Khan, Muhammad Ahsan, Heminder Singh, Mohammed Taleb, Sohail Ali
Journal: Circulation (2022)

Background: There is a paucity of data on predictors of mortality in all-cause coronary artery dissection patients. The purpose was to study the baseline characteristics, associated co-morbidities, and in-hospital mortality in coronary artery dissection patients using the Healthcare Cost and Utilization Project National Inpatient Sample database. Methods: The Healthcare Cost and Utilization Project administrative longitudinal database contains encounter-level information on inpatient stays, emergency department visits, and ambulatory surgery in all U.S. hospitals. We performed a cross-sectional analysis on 25005 patients diagnosed with coronary artery dissection during hospitalization from January 2016 to December 2018. The primary outcome was in-hospital mortality. Results: Of the total patient population, 25005 patients were found to have coronary artery dissection. All patients with ages ≥ 18 were included in the study (24980). The observed overall in-hospital mortality was 6.0% (1498 patients out of 24980). The higher mortality was observed in age group &gt;80 years when compared to the age group &lt;40 years (adjusted odds ratio: 8.5; 95% confidence interval: 5.7 to 12.4; p-value &lt; 0.01). Patients with peripheral vascular disease (adjusted odds ratio: 2.0; 95% confidence interval: 1.7 to 2.3; p-value &lt; 0.01) and cardiogenic shock (adjusted odds ratio: 10.8; 95% confidence interval: 9.5 to 12.2; p-value &lt; 0.01) showed higher mortality (Table 1,2). Conclusion: To the best of our knowledge, this is the largest population-based study investigating the predictors of in-hospital mortality in all-cause coronary artery dissection patients. Our analysis showed higher mortality with increasing age and in patients who developed cardiogenic shock and those with peripheral vascular disease.
Abstract 14513: An Aberrant Friend - Using Bundle Branch Block for Septal Accessory Pathway Localization
Authors: Syed Rafay Ali Sabzwari, Christopher Barrett, James Mann, LUKASZ CERBIN, Lohit Garg, Alexis Tumolo, Amneet Sandhu, Michael Rosenberg, Ryan G Aleong, Paul D Varosy, Matthew Zipse, Wendy Tzou, John West, Jose Sanchez
Journal: Circulation (2022)

Introduction: While changes in the ventriculoatrial (VA) time with RBBB or LBBB during ORT utilizing a free wall accessory pathway (AP) is well described, such a change in VA time can also be helpful in identifying the location of a septal AP. Objectives: To demonstrate the effect of RBBB and LBBB aberrancy on the VA time for ORT involving septal AP and thereby assist in identifying a posteroseptal AP. Results: A 51-year-old man with WPW syndrome was referred for EP study and ablation due to palpitations. With programmed atrial extrastimulation, an atypical echo beat was noted. While attempting to induce tachycardia, double atrial extrastimuli resulted in non-sustained ORT both with RBBB and LBBB aberrancies (Figure). Measurement of the VA time during non-sustained ORT demonstrated a VA time that was longer in the presence of LBBB aberrancy (110ms) than RBBB aberrancy (97ms) compared to narrow QRS (95ms). Electroanatomic mapping identified the earliest atrial activation of the echo beat on the right posteroseptum. Radiofrequency ablation at this site resulted in immediate loss of ventricular pre-excitation. Conclusions: Changes in the VA interval during AP-mediated SVT are especially important for pathway localization. As demonstrated in prior studies, for free wall APs, the difference between sinus and bundle branch block time (ΔVA) is usually &gt;35ms compared to &lt;35ms for septal APs. Furthermore, studies described that for septal APs, posteroseptal APs have a greater VA time with LBBB, anteroseptal APs with RBBB and no significant change in VA time with midseptal APs. By demonstrating both RBBB and LBBB aberrancy in this patient, this case uniquely validates the concept that the VA time with LBBB aberrancy is greater with posteroseptal APs.
Abstract 15787: Depending on Chain Length Plasma Ceramides Are Associated With Higher or Lower Cardiorespiratory Fitness in the General Population
Authors: Jule Zatloukal, Stephanie Zylla, Marcello Ricardo Paulista Markus, Ralf Ewert, Sven Gläser, Henry Volzke, Diana Albrecht, Nele Friedrich, Matthias Nauck, Linda R Peterson, Xuntian Jiang, Jean E Schaffer, Stephan B Felix, Marcus Dorr, Martin Bahls, Stefan Gross
Journal: Circulation (2022)

Introduction: Ceramides are promising new predictive biomarkers for cardiovascular diseases (CVD), but their main mode of action is still unknown. As low cardiorespiratory fitness (CRF) is also linked with CVD, we investigated the association of three of the most abundant blood plasma ceramides and their respective ratios with CRF in a large population-based study. Hypothesis: Plasma long-chain ceramide levels are positively associated with higher CRF in the general population, while higher short-chain ceramide levels are associated with lower CRF. Methods: Levels of C16:0, C22:0, and C24:0 ceramide were quantified by a liquid chromatography-mass spectrometry and CRF was measured by a cardiopulmonary exercise test in the first follow-up of the Study of Health in Pomerania (SHIP-START-1; n = 1,105; mean age 50.3 years). Multivariable linear regression models were used to assess the association between ceramides and CRF. Results: Higher C24:0 levels as well as C24:0/C16:0 ratio were significantly associated with higher CRF, while higher levels of C22:0 or C22:0/C16:0 ratio were associated with lower CRF. Furthermore, we found that body mass index (BMI) interacts with these associations, whereas neither, sex, beta blockers nor lipid-lowering medication had any effect modifying influence. Conclusions: This study showed that ceramides are associated with CRF, one of the most important risk factors of CVD. Ceramide C24:0 as well as C24:0/C16:0 ratio might be beneficial regarding CRF, whereas C22:0 and C22:0/C16:0 ratio might be detrimental. Our study results were independent of many cardiovascular risk factors, which highlights ceramides as potential predictive biomarkers. Future studies with larger numbers of subjects are needed to verify these results, and to evaluate whether the observed interaction with BMI could limit the use to specific BMI subgroups.
Abstract 14442: Longitudinal Cardio-Oncology Trends in Sex and Racial Disparities in PCI and Inpatient Mortality: Machine Learning Augmented Propensity Score Analysis of Over 101 Million Hospitalizations
Authors: Dominique Monlezun, Efstratios Koutroumpakis, Gloria Iliescu, rishi patel, Aamuktha Karla, Jin wan Kim, Kevin Honan, Jong Kun Park, Sofia Alexandrescu, Myrshia Woods, Mehmet Cilingiroglu, Konstantinos Marmagkiolis, Cezar Iliescu
Journal: Circulation (2022)

Introduction: The longitudinal trends of cardio-oncology healthcare disparities is unknown. Methods: We performed the first nationally representative longitudinal analysis using Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) and the 2016-2018 National Inpatient Sample (NIS), the United States’ largest all-payer inpatient dataset. Results: Among 101,521,656 hospitalizations from 2016-2018, 3,233,249 (3.18%) were female with active cancer, 18,310 (0.57%) had STEMI, 4,670 (0.14%) received LHC, 3,360 (0.10%) received PCI, and 160 (0.005%) received percutaneous heart pump (Impella). The most common active primary malignancies significantly differed for females (lung [15.19%], breast [14.10%], uterus [10.60%], leukemia [8.88%], and non-Hodgkin lymphoma [NHL] [6.92%]) versus males (prostate [15.56%], lung [15.21%], leukemia [10.05%], NHL [8.50%], and colon [6.57%]) (p&lt;0.001). Among those with active cancer and STEMI, white females versus white males had similar likelihood of PCI, but nonwhite females versus nonwhite males were significantly less likely to receive PCI in 2016 (43.86% versus 52.20%, p=0.009), 2017 (25.64% versus 30.52%, p=0.039) and 2018 (11.10% versus 14.73%, p=0.001). In ML-PS multivariable regression fully adjusted for age, sex, race, income, region, STEMI, metastasis, NIS-calculated mortality risk by DRG, and the likelihood of receiving PCI, in 2016 PCI had less mortality reduction for females (OR 0.68, 95%CI 0.55-0.85; p&lt;0.001) than males (OR 0.58, 95%CI 0.49-0.68; p&lt;0.001) with nearly equal in 2017 for females (OR 0.50, 95%CI 0.34-0.74; p&lt;0.001) and males (OR 0.50, 95%CI 0.38-0.66; p&lt;0.001), but in 2018 there was a comparable non-significant mortality reduction for both females or males. Conclusions: Our study provides novel evidence that female racial minorities receive post-STEMI PCI at lower rates than male racial minorities, white females, and white males, though mortality disparities appear to have a favorable trend over time.
Abstract 14883: Non-Vitamin K Oral Anticoagulants versus Warfarin After Watchman Device Implantation: A Systematic Review and Meta-Analysis
Authors: Nicole Felix, Lara Melo Soares Pinho de Carvalho, Isadora Maria Zuquello, Cora Vale, Rhanderson Cardoso
Journal: Circulation (2022)

Introduction: Postprocedural anticoagulation is indicated for at least 45 days in patients who undergo percutaneous left atrial appendage occlusion with the Watchman device. The relative efficacy and safety of non-vitamin K oral anticoagulants (NOACs) to warfarin for postprocedure anticoagulation in this setting is not well known. Methods: We conducted a systematic review and meta-analysis to compare NOACs with warfarin in patients who underwent left atrial appendage occlusion with Watchman. PubMed, Cochrane, and EMBASE were systematically searched. We included randomized and observational studies with at least 45 days of follow-up following Watchman implantation comparing anticoagulation with NOACs vs. warfarin for thrombotic and hemorrhagic outcomes. Results: We included 11 studies with 2,325 patients who underwent Watchman device implantation and were anticoagulated with NOACs (n=1,194; 51.35%) or warfarin (n=1,131; 48.65%). NOACs were associated with a lower incidence of major bleeding (OR 0.49; 95% CI 0.28-0.89; p=0.02; Fig. 1A) and device-related thrombosis (OR 0.44; 95% CI 0.21-0.93; p=0.03; Fig. 1B). There was no significant difference between NOACs and warfarin with regards to stroke or transient ischemic attack (OR 0.43; 95% CI 0.15-1.28; p=0.13; Fig. 2). Conclusions: In this meta-analysis, NOACs were associated with lower risks of device-related thrombosis and major bleeding relative to warfarin in patients who undergo Watchman implantation.
Abstract 15276: Polygenic Susceptibility to Dilated Cardiomyopathy Underlies Peripartum, Alcoholic, and Chemotherapy-Induced Cardiomyopathies
Authors: Dimitri J Maamari, Kiran J Biddinger, Sean J Jurgens, Liam Gaziano, Joel T Rämö, Carlos A Gongora, Dolphurs Hayes, Seung H Choi, Amy Sarma, Tomas G Neilan, Amit V Khera, Patrick T Ellinor, Krishna G Aragam
Journal: Circulation (2022)

Introduction: Rare (monogenic) variants linked to dilated cardiomyopathy (DCM) are enriched among individuals with peripartum (PPCM), alcoholic (ACM), and chemotherapy-induced cardiomyopathies (CCM), but are present in &lt;15% of cases. Whether a common-variant (polygenic) susceptibility to DCM is also shared across these secondary cardiomyopathies is unknown. Methods: Cases of DCM, PPCM, ACM, and CCM were adjudicated using hospital billing codes only (in UK Biobank), or with additional chart reviews conducted by 2 medical doctors blinded to the genetic data (in Mass General Brigham [MGB] Biobank). A DCM polygenic score predicated on imaging-based measures of left ventricular structure and function was tested for association with each condition. In a subset of MGB Biobank participants with whole exome sequencing data, we determined the proportion of cases with a monogenic variant and/or a high (≥90 th percentile) polygenic score. Results: In MGB Biobank (n=30,837) and UK Biobank (n=304,687), 193 cases of PPCM (n=18), ACM (n=127) or CCM (n=48) were identified. A DCM polygenic score comprising 2.3 million common genetic variants associated comparably with DCM and all three secondary cardiomyopathies (meta-analyzed p&lt;0.001 for all) ( Figure ). Among chart-validated phenotypes in MGB Biobank, cases had higher median polygenic score percentiles than controls (Controls=50; DCM=68; PPCM=86; ACM=70; CCM=59), and a high polygenic score conferred 3.3-fold odds of any secondary cardiomyopathy (p&lt;0.001). In the whole exome sequencing subset (N=21,378; n=65 secondary cardiomyopathy cases), 9.2% of secondary cardiomyopathy cases harbored a monogenic variant, while 21.5% had a high polygenic score (including 1.5% who had both). Conclusion: Individuals with PPCM, ACM, and CCM are enriched for a high DCM polygenic score, further suggesting that these conditions arise from unique, extrinsic insults acting in the context of a common, underlying genetic susceptibility.
Abstract 14547: A Rare Case of Pericardial Effusion Causing Cardiac Tamponade in Preeclampsia
Authors: Saif ur Rehman, Zauraiz Anjum, Ayesha Javed, Amr Salama, Hongli Liu, Uzma Iqbal
Journal: Circulation (2022)

Background: Cardiovascular manifestations of preeclampsia are caused by increased peripheral vascular resistance and systemic endothelial damage causing third spacing of fluids. Usually this presents as lower extremity edema or non-cardiogenic pulmonary edema. Here we report a rare case of third spacing into pericardial space causing cardiac tamponade in a patient with severe pre-eclampsia. To our knowledge, only 2 similar cases have been reported so far. Case presentation: 35-year-old female G1P0A0 presented to the hospital at 36 weeks and 6 days of gestation with complaints of elevated blood pressure, headache, blurring of vision, and shortness of breath. On physical exam, she had blood pressure of 170/85, 3+ bilateral lower extremity edema and labs showed urine protein to creatinine ratio of 13,962. She was diagnosed with severe pre-eclampsia and underwent emergent C-section without any complications. On postoperative day 1, patient continued to complain of shortness of breath and became hypoxic requiring 2 to 3 L of supplemental oxygen. Chest x-ray showed slight pulmonary edema but BNP was 49. She had persistent lower extremity swelling and was empirically diuresed with IV Lasix with some improvement in her symptoms. An echocardiogram showed large circumferential pericardial effusion with early right ventricular diastolic collapse consistent with cardiac tamponade. Her LV function was normal with an EF of 70% without any wall motion abnormalities. She was taken to the Cath Lab for pericardiocentesis and underwent drainage of almost 650 cc of yellowish clear-colored fluid. Analysis of the fluid showed 1186 nucleated cells, pH 7.5, and protein of 2.9 mg/dl. Her ANA and Rheumatoid factor were negative. The pericardial drain was removed after 5 days with no evidence of recurrence of tamponade on repeat echo. Conclusion: Peripartum shortness of breath with leg swelling is a common complain among pregnant women with pre-eclampsia. Although peripartum cardiomyopathy is more common, pericardial effusion with cardiac tamponade is also a potential diagnosis and should be kept in the differential. Echocardiography can differentiate these entities.
Abstract 15263: Trends and Clustering in Cardiovascular Health Metrics by Race and Ethnicity Among US Adults, 2011-2020
Authors: Yuan Lu, Xumin Li, Yuntian Liu, Erica S Spatz, Jeph Herrin, Harlan M Krumholz
Journal: Circulation (2022)

Introduction: Nationally representative data evaluating recent trends and clustering in cardiovascular health metrics by race and ethnicity are sparse. Methods: We evaluated 10-year trends and clustering in cardiovascular health metrics in 10,300 individuals who attended the morning fasting examination, using data from the National Health and Nutrition Examination Surveys (NHANES) from 2011 to 2020. We assessed the time trends of the mean score of the 7 cardiovascular health metrics by race and ethnicity. Then we ranked the top 10 mutually exclusive phenotypes of the 7 cardiovascular health metrics for each race and ethnicity. Results: Among participants, the mean age was 48.3 (SD, 4.2) years; 52% were female; 6.3%, 71.3%, 12.7%, and 9.7% were Asian, White, Black, and Hispanic. From 2011 to 2020, the total cardiovascular health score decreased significantly for Asian individuals (P=0.005) but did not change significantly for Black, Hispanic, and White individuals (P&gt;0.05 for all). The mean scores for individual cardiovascular health metrics did not change by racial/ethnic subgroups, except for a decrease in mean body mass index (BMI) score in Asian individuals, an increase in mean total cholesterol score in Black individuals, a decrease in mean fasting glucose score in Asian, Hispanic, and White individuals. Among all the individuals, healthy diet and the combination of healthy diet and physical activity were the two most prevalent phenotypes, followed by several different combinations of physical activity, BMI, healthy diet, and smoking. Conclusions: Temporal trends suggest an overall unchanged mean total cardiovascular health score for Black, Hispanic, and White individuals and a decreased score for Asian individuals. There were persistent racial/ethnic disparities in the individual cardiovascular health metrics and phenotypes. Across all racial/ethnic subgroups, large opportunities exist for improvements.
Abstract 15229: An Artificial Intelligence Deep Neural Network Analysis of the 12-lead Electrocardiogram Distinguishes Patients With Congenital Long Qt Syndrome From Patients With Acquired Qt Prolongation
Authors: Johan M Bos, Kan Liu, Zachi Attia, Peter A Noseworthy, Paul Friedman, Michael J Ackerman
Journal: Circulation (2022)

Introduction: Over 100 FDA-approved medications, electrolyte perturbations, and many disease states can prolong the QTc beyond its 99 th percentile value resulting in acquired QT prolongation. In contrast, approximately 1 in 2000 people have congenital long QT syndrome (LQTS) hallmarked by pathological QT prolongation secondary to genetic defects in the heart. Hypothesis: An artificial intelligence (AI) deep neural network (DNN) can distinguish patients with LQTS from those with acquired QT prolongation. Methods: The study cohort included all patients with LQTS evaluated in the Windland Smith Rice Genetic Heart Rhythm Clinic and controls from Mayo Clinic’s ECG data vault comprising over 2.5 million patients. For the AI-DNN model, every patient/control with ≥ 1 ECG above age- and sex- specific 99 th percentile values for QTc [&gt; 460 ms for all patients (male/female) &lt; 13 years of age, or &gt; 470 ms for men and &gt; 480 ms for women above this age] was included. An AI-DNN involving a multi-layer c onvolutional n eural n etwork (CNN) was developed to classify patients. LQTS patients were age- and sex- matched to controls at 1:5 ratio. Results: Among the 1,599 patients with genetically confirmed LQTS, 808 had ≥ 1 ECG with QTc above the threshold (2,987 ECGs) compared to 361,069/2.5M controls (14% of Mayo Clinic patients getting an ECG, ‘presumed negative’; 989,313 ECGs). Following age- and sex- matching and splitting, 3,309 (training), 411 (validation) and 887 (testing) control ECGs were used. This model distinguished LQTS from those with acquired QT prolongation with an AUC of 0.896 (accuracy 85%, sensitivity 77%, specificity 88%, PPV 0.58, NPV 0.94). After exclusion of patients with a wide QRS (&gt;150 ms) or pacemaker, the model remained successful in distinguishing the two groups (AUC 0.85, accuracy 78%, sensitivity 78%, specificity 87%, PPV 59%, NPV 94%). Conclusions: For patients with a QTc exceeding its 99 th percentile values, this novel AI-DNN functions as a LQTS mutation detector being able to identify patients with abnormal QT prolongation secondary to a LQTS-causative mutation rather than acquired QT prolongation with a &gt;50% positive predictive value. This algorithm may facilitate screening for this potentially lethal, yet highly treatable, genetic heart disease.
Abstract 15640: Histomic-Based Clot Structure Quantification for Prediction of Ischemic Stroke Etiology
Authors: Tatsat Rajendra Patel, Briana Santo, TaJania Jenkins, Muhammad Waqas, Andre Monteiro, Ammad Baig, Elad Levy, Adnan H Siddiqui, John Kolega, John Tomaszewski, Vincent M Tutino
Journal: Circulation (2022)

Introduction: Determining stroke etiology is paramount to clinical management and prevention of recurrent strokes. Although stroke patients undergo extensive post-treatment work-ups, 30-40% of cases remain cryptogenic. Hypothesis: Engineered histomic features from digital pathology images of stroke blood clots collected during mechanical thrombectomy (MT) can be used to delineate stroke etiology. Methods: For clots retrieved from patients undergoing MT, etiology was determined by the trial of Trial of Org 10172 in Acute Stroke Treatment (TOAST) score. After sectioning and H&amp;E staining, clot components (red blood cells-RBCs, fibrin-platelet regions-FP, and white blood cells-WBCs) were segmented from whole slide images. Histomic features were engineered to capture the structural distribution of RBC/FP regions throughout the clot. To measure clot WBC diversity, WBC instances were clustered into WBC “classes” based on texture, and summarized as a class frequency distribution (CFD). The three most significant RBC/FP and WBC features between large artery atherosclerosis (LAA) and cardioembolic (CE) cases were used to train a complement Naïve Bayes (CNB) model, which was then implemented to predict the etiology of cryptogenic cases. Results: In our data (n=53), 31 clots were CE, 8 were LAA, 4 were from strokes of other determined etiology, and 10 were cryptogenic. 17 significant RBC/FP features and 3 significant WBC CFDs were different between CE and LAA. The trained CNB model accurately classified CE vs. LAA with a validation AUC of 0.87±0.03, exhibiting superior performance to a model trained using common clot percent cellular composition metrics (AUC=0.69±0.16). Furthermore, we showed the potential to classify cryptogenic cases as CE or LAA. Conclusions: This first-of-its-kind, biologically-informed clot histomic pipeline captured significant information that may augment clinical and laboratory features used in stroke etiology classification.